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V28 HCC 23Community non-dual aged RAF 0.186

Prostate, Breast, and Other Cancers and Tumors

Under the CMS-HCC V28 risk adjustment model (PY2026 Medicare Advantage), HCC 23 carries a community non-dual aged RAF of 0.186, and 234 payable ICD-10-CM diagnosis codes map to it. In the V28 hierarchy it is superseded by HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, HCC 22 when a more severe category in the same disease group is also present.

Medically reviewed by Jess P., CPC · Reviewed: May 30, 2026

RAF factors

The community factor varies by Medicaid and originally-disabled status; the institutional factor applies to long-term-institutional members. These are the CMS-HCC V28 PY2026 relative factors.

Community NA: 0.186Community PBA: 0.203Community FBA: 0.196Community ND: 0.233Community PBD: 0.237Community FBD: 0.218Institutional: 0.197

Combine this factor with demographics and other HCCs in the RAF score calculator to model the full CMS-HCC V28 RAF for a member.

V28 hierarchy

Trumped by: HCC 17, HCC 18, HCC 19, HCC 20, HCC 21, HCC 22 (a more severe category in the same disease group supersedes this one).

ICD-10-CM codes that map to HCC 23 (234)

Payable diagnosis codes that map to this category under CMS-HCC V28 PY2026. Open any code for its full description, HCC mapping, and coding guidance.

Coder workflow notes

Get the V28 RAF + MEAT cheat sheet

A printable one-pager for HCC 23: which member codes risk-adjust, the RAF weight, and the MEAT your notes need to make it stick. Free, no card.

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Frequently asked questions

What is CMS-HCC V28 category 23?

HCC 23 is "Prostate, Breast, and Other Cancers and Tumors", a payment Hierarchical Condition Category in the CMS-HCC V28 risk adjustment model (100% phase-in for payment year 2026). 234 payable ICD-10-CM codes map to it.

What is the RAF weight for HCC 23?

The community non-dual aged relative factor for CMS-HCC V28 category 23 is 0.186. The exact factor varies by enrollment segment (community Medicaid and originally-disabled status, and institutional); the full segment table is published in the CMS V28 Rate Announcement.

How many ICD-10-CM codes map to HCC 23?

234 payable ICD-10-CM diagnosis codes map to CMS-HCC V28 category 23 (Prostate, Breast, and Other Cancers and Tumors) for payment year 2026.

Which categories trump HCC 23 in the V28 hierarchy?

HCC 23 is superseded by HCC 17 (Cancer Metastatic to Lung, Liver, Brain, and Other Organs; Acute Myeloid Leukemia Except Promyelocytic), HCC 18 (Cancer Metastatic to Bone, Other and Unspecified Metastatic Cancer; Acute Leukemia Except Myeloid), HCC 19 (Myelodysplastic Syndromes, Multiple Myeloma, and Other Cancers), HCC 20 (Lung and Other Severe Cancers), HCC 21 (Lymphoma and Other Cancers), HCC 22 (Bladder, Colorectal, and Other Cancers). When a more severe category in the same disease group is documented, it is counted instead of HCC 23.

Related condition guides

In-depth HCC coding guides for conditions that map to category 23, with documentation tips, common mistakes, and the V24-to-V28 changes.

Related references

Sources

CMS published ICD-10-CM mapping file plus CMS-HCC v28 PY2026 model software. CMS-HCC V28 model published at CMS.gov Risk Adjustors; ICD-10-CM member codes from the CMS ICD-10-CM code set.

Verified current to CMS-HCC V28, payment year 2026 — last reviewed May 30, 2026.